Dear Dr. Phelps:
I have been diagnosed with Bipolar II, though I am told it is complex and difficult to assess as times.  I also had a spinal fusion several years ago and now am having more pain.  One consideration is that I might have arachnoiditis, which can be treated, apparently, with neurontin.  Do you have any experience with patients who are receiving such medication for both back and brain issues? I am not currently taking any medications, except ultram for pain.   Please comment.

Thank you.
 

Dear Mr. or Ms. C'
Neurontin can be excellent for pain.  In my experience it's not at all good as a long term mood stabilizer, and in fact it quite often has a destabilizing effect rather like antidepressants (it has substantial antidepressant effects also in many people). The most recent studies show that it is no better as a mood stabilizer than placebo -- and yet in the short run it clearly helps quite a few folks with bipolar disorder, which must mean that there are quite a few folks getting worse on it too to come out "average". 

However, if it worked great for the pain, you might do well with it for a while, or be able to combine it with another true mood stabilizer.  Alternatively, carbamazepine, another routine mood stabilizer we've used for years, has substantial anti-pain properties.  A new version of the molecule with an oxygen stuck on it seems to work about the same, including the anti-pain effects, but has substantially fewer side effects (Trileptal).  

Dr. Phelps

Published December, 2001